The article elaborates the Challenge and Problems of the medical education in China in the 21th century aswell as the importance of studying these problems.[

Objective: To investigate the trends in incidence and mortality of lung cancer in Kaihua County, Zhejiang Province from 2011 to 2022, so as to provide insights into improving lung cancer prevention and control strategy. Methods: The incidence and mortality of lung cancer in Kaihua County from 2011 to 2022 were collected through Zhejiang Provincial Chronic Disease Surveillance Information Management System. The crude incidence, standardized incidence, crude mortality and standardized mortality of lung cancer were analyzed, and the trends in incidence and mortality of lung cancer were evaluated using average annual percent change (AAPC). Results: The crude and standardized incidence of lung cancer appeared a tendency towards an increase (AAPC=5.409% and 2.957%, both P<0.05) from 2011 to 2022, with an average annual crude incidence of 75.17/105 and average annual standardized incidence of 44.37/105. Average annual crude incidence (100.16/105 vs. 48.55/105) and standardized incidence (58.03/105 vs. 30.61/105) of lung cancer was higher in males than in females (both P<0.05). The crude incidence of lung cancer in males appeared a tendency towards an increase (AAPC=2.878%, P<0.05), with no significant changing patterns seen in standardized incidence (P>0.05). The crude and standardized incidence of lung cancer in females showed a tendency towards an increase (AAPC=11.596% and 10.464%, both P<0.05). The crude incidence of lung cancer increased rapidly among residents at ages of 45 years and older, and peaked among residents at ages of 80 to 84 years (32.11/105). The crude and standardized mortality of lung cancer appeared a tendency towards a rise and decline (AAPC=1.554% and -2.491%, both P<0.05) from 2011 to 2022, with an average annual crude and standardized mortality of 52.83/105 and 29.09/105. Average annual crude mortality (77.92/105 vs. 26.10/105) and standardized mortality (43.66/105 vs. 14.33/105) of lung cancer was higher in males than in females (both P<0.05). The crude mortality of lung cancer in males appeared a tendency towards a rise, while the standardized mortality appeared a tendency towards a decline (AAPC=1.436% and -2.553%, both P<0.05). No significant changing patterns were seen in crude and standardized mortality of lung cancer in females (both P>0.05). The crude mortality of lung cancer increased rapidly among residents at ages of 50 years and older, and peaked among residents at ages of 80 to 84 years (37.26/105). Conclusions The incidence and mortality of lung cancer appeared a tendency towards an increase in Kaihua County from 2011 to 2022, and a rapid increase was seen in the incidence of lung cancer in females.

Objective To evaluate the diagnosis value of C-12 multiple tumor marker protein chip detective system for lung cancer. Methods The serum levels of 12 tumor makers were measured in 172 lung cancer patiens,52 pulmonary benign diseases patients. All lung cancer patients were definitly diagnosised by cytology or histology, including 89 squamous cell carcinoma patients, 72 bronchogenic adenocarcinoma patients, 11 small cell lung cancer patients; 12 patients in stage I, 28 patients in stageII, 65 patients in stage III, 67 patients in stage IV. The 12 common tumor markers in serum included CA199, NSE, CEA, CA242, CA125, CA153, AFP, Ferrtin, free-PSA, PSA, HGH, ?-HCG. Results At least one kind of tumor maker was found higher in 128 of the 172 lung cancer patients, the positive rate was 74.42%, and in 5 of the 52 pulmonary benign diseases patients, the positive rate was 9.62%,it is statistical significance between two the groups (P0.05) in different pathological types lung cancer patients .The positive rate was statistical significance in different stage lung cancer patients , the highest positive rate which in stage IV patients was 79.2% (P

Objective To evaluate the mid-term outcomes of endovascular repair of descending thoracic aortic aneurysm(DTAA) in high-risk patients.Methods Twenty four patients with DTAA received stent-grafts implantation between January 2001 and July 2007 and their clinical data were retrospectively analyzed.All patients were considered high-risk for open surgical repair due to the location or rupture of the aneurysm,high age and severe comorbidities.Spiral computed tomography angiography and 3-dimentional reconstructions were performed at 1,3,6 and 12 months postoperatively and thereafter every year.Results The primary operational success rate was 100%.There were 2 deaths(8.3%) during perioperative period due to multiorgan failure and acute myocardial infarction respectively.Two(8.3%) patients had severe post-operational complications(1 stroke and 1 acute renal insufficiency).Eleven cases of type Ⅰ(46%) endoleak were detected immediately after the operation and among them,the endoleak disappeared after balloon dilatation in 3 cases while the other 8 patients were treated conservatively.Follow-up of 1 to 60 months(mean 18.6?4.2 months) was completed in 19 patients(79.2%).Stent displacement with type Ⅰ endoleake was found in 1 patient at 4 years after the operation and delayed type Ⅲ endoleak occured in another patient at 2 years post-operation.Both patients received endovacular repair again and the endoleaks were closed successfully.One patient died of colon cancer during the follow up.Complete thrombosis of the thoracic aneurysm sac and no stent migration or endoleak was found on the followup CT at 3 months after the operation in all the patients.The decrease in maximal aneurysm diameter was 0-18 mm(mean 6.3?3.1 mm).The prosthetic vascular grafts implanted in 4 patients with preliminary carotid subclavian bypass surgery were patent during the follow-up period.Conclusion Treatment of descending thoracic aortic aneurysm in high-risk patients with endovascular approach showed acceptable early mortality and morbidity and may be considered as a treatment alternative for carefully selected patients.

Objective To study the inhibitory effect of APE1 expression vector pSilence APE1 on growth of osteosarcoma in nude mice, and to elucidate the role of APE1 in pathogenesis and development of osteosarcoma. Methods Nude mice model bearing osteosarcoma was reproduced by implanting human osteosarcoma cell line 9901. Twenty mice were randomly divided into two groups: control group in which the mice were treated with lipofectamine, and experimental group in which the mice were treated with pSilence APE1. The tumor inhibition rate was calculated after 12 days of treatment. Meanwhile, the expression of APE1 protein, intratumor microvessel density (MVD), and proliferation index were observed by immunohistochemistry. Apoptosis index was assessed by terminal dUTP nick end labeling (TUNEL) technique. Results Down-regulation of APE1 expression of tumor cells was found in the group treated with pSilence APE1. The tumor inhibition rate was 38.23%. The intratumoral microvessel density (MVD) in experimental groups and proliferation index were significantly lower than the control group, while the apoptosis index was much higher. Conclusion Targeted knock down of APE1 by pSilence APE1 may inhibit the growth of osteosarcoma in vivo.

Objective To explore the relation between changes in apurinic/apyrimidinic endonuclease (APE1) gene expression and effects of melphalan on multiple myeloma (MM) cells. Methods Expression of APE1 protein was detected in MM cell line KM3 using immunocytochemical staining and Western blot assay after 0~15?mol/L melphalan treatment for 1~2d. Integral optical density was determined by means of image analysis system. Results There was positive relationship between levels of APE1 protein in KM3 cells and the treatment time and dose of melphalan. Conclusion Expression of APE1 protein could be induced by melphalan treatment. The result suggests that a high expression of APE1 protein may play a certain role in the resistance of multiple myeloma to melphalan.

Objective To investigate the effect of caffeic acid phenethyl ester (CAPE) on the growth of human colorectal carcinoma cell line HCT116 transplanted subcutaneously in nude mice. Methods Nude mouse model of human colorectal carcinoma by subcutaneous transplantation of HCT116 cell line was reproduced. A total of 20 mice were divided into 2 groups: control group and CAPE group (oral administration of CAPE at 5mg/mice/d). The growth of the subcutaneously transplanted tumor and changes in mouse body weight in each group after treatment were observed on 7, 14, 21 and 28d. Histopathological examination of xenograft, heart, liver, lung, kidney and intestine of nude mice was also conducted. Apoptosis index was detected by terminal dUTP nick end labeling (TUNEL) technique. Results CAPE had significantly inhibitory effect on growth of the transplanted xenograft in vivo. Tumor volume and tumor weight were decreased (P

OBJECTIVE: Small diameter vascular grafts (＜ 6 mm) are used predominantly in revascularization and reconstructive procedures. The small diameter vascular grafts already used in our clinical practice include autologous veins or arteries, polyethylene terephthalate (Dacron) and expanded polytetrafluoroethylene (ePTFE) synthetic vascular grafts. Unfortunately these vascular grafts all have some disadvantages that prohibit their uses. Therefore search for ideal small diameter vascular grafts has become the focus in recent years.DATA SOURCES: A computer-based online search of Pubmed database was undertaken to identify the articles about small diameter vascular grafts published in English between January 1990 and January 2007 with the key words of "prosthetic graft, vascular bypass graft, small diameter vascular graft, tissue engineering".STUDY SELECTION: The data were selected firstly to choose the full-text of articles met the criteria. Inclusion criteria: ① Articles about biological vascular grafts; ②Articles about synthetic vascular grafts; ③Articles about small diameter tissue engineering blood vessels. Exclusion criteria: Repetitive or analogical articles or case reports.DATA EXTRACTION: Totally 113 articles on small diameter vascular grafts were collected and 41 met the inclusive criteria after eliminated the repetitive or similar studies or case reports.DATA SYNTHESIS : Although biological vascular grafts have the outstanding advantages, such as superior long-term patency, relatively resistant to infection, minimal thromboembolism, etc., they also have predominant disadvantages of limited availability, durability and aneurysm formation. Dacron and ePTFE are currently the standard synthetic vascular grafts in the vascular bypass surgery, but their immediate or long-term patency rates are relatively poor due to compliance mismatch, thrombogenicity and poor haemodynamics, especially when they are used in small diameter revascularization and reconstructive procedures. Thus, various modifications have been applied to Dacron and ePTFE grafts to improve their function. In recent two decades, the emergence of tissue-engineering technology has made the development of a novel biologically viable vascular substitute feasible, and it may prove to be the ultimate solution for better small-diameter vascular grafting.CONCLUCTION: So far there is no completely biodegradable small diameter vascular graft suitable for the arterial circulation in humans. Construction of an ideal small-diameter vascular graft will require an interdisciplinary effort requiring critical contributions from biologists, engineers, and clinicians, with strong collaborations among these 3 fields being crucial to success.

Objective To establish a model to predict the clinical response of neoadjuvant chemotherapy for nasopharyngeal car‐cinoma ,and provide basis for the individual treatment .Methods The clinical data of 63 cases of advanced nasopharyngeal carcinoma patients who have received neoadjuvant chemotherapy in the past 2 years were analyzed retrospectively .Univariate and multivariate analyses were performed using the Logistic analyses to identify efficacy factors .Results The response rate in nasopharyngeal tumor and lymph node metastasis were 39 .7% and 50 .8% ,respectively .Single factor analysis showed that patients with no distant metas‐tasis ,cranial nerve inviolated ,EBV negative and high expression of Ki67 were more sensitive to therapy .Logistic analysis showed that the influencing factors for the effect of the new chemotherapy include :distant metastasis ,cranial nerve inviolated and EBV . Thus ,the prediction model would be:Logit= -0 .470 -2 .863 × distant metastasis + 1 .328 × cranial nerve invasion+ 3 .639 × EBV ,its sensitivity ,specificity ,positive predictive value and negative predictive value were 79 .4% ,82 .8% ,84 .4% and 77 .4% . Conclusion The distant metastasis ,cranial nerve invasion and EBV infection were important predictive factors for neoadjuvant chemotherapy of nasopharyngeal carcinoma .This model could be used to predict the response of patients with nasopharyngeal carci‐noma .

Objective To investigate the value of combined detection of multi-tumor markers in the diagnosis of primary hepatocellular carcinoma (HCC) and to establish the discriminant equation. Methods Using a protein chip, 12 tumor markers in the serum from 98 patients with HCC and 67 patients with benign liver diseasewho had been admitted to Daping Hospital from November 2003 to April 2006, and 46 healthy individuals during he same period were analyzed. A discriminant equation was established to discriminate primary HCC from benign liver diseases. All the data were processed by variance analysis and chi-square test. Results The positive rates of the tumor markers were 89% (87/98) in patients with primary HCC, 19% (13/67) in patients with benign liver disease and 4% (2/46) in healthy individuals. There was statistical difference in the serum level of alpha-fetoprotein (AFP), eareinoembryonic antigen (CEA), ferritin (FER), CA19-9 and CA125 among the 3 groups (F =59.530, 40.472, 31.708, 75. 897, 153.066, P <0.05). Combined detection of AFP, CEA, FER, CA19-9 and CA125 improved the diagnostic accordance rate to 89%, which was significandy higher than the diagnostic accordance rate (64%) when only AFP was detected (X2 = 16.362, P <0.05). The accuracy of the discriminant equation was 90%. Conclusions Combined detection of multi-tumor markers is superior to AFP detection. Combined detection of multi-tumor markers can be used in screening of the HCC patients in HCC high risk population and in the early diagnosis of primary HCC.